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Biomedicines
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Glaucoma: New Diagnostic and Therapeutic Approaches
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Glaucoma: New Diagnostic and Therapeutic Approaches

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: 31 May 2024 | Viewed by 4661

Special Issue Editor

Dr. Da-Wen Lu

E-Mail Website
Guest Editor
Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
Interests: glaucoma; ocular pharmacology; cataract

Special Issue Information

Dear Colleagues,

We are delighted to present a Special Issue, entitled "Glaucoma: New Diagnostic and Therapeutic Approaches," focusing on the latest advancements in the field of glaucoma management. Glaucoma remains a leading cause of irreversible blindness worldwide, necessitating continuous exploration of novel approaches to improve patient outcomes. This Special Issue aims to provide a comprehensive overview of cutting-edge research and innovations in glaucoma management, highlighting emerging techniques and interventions that hold promise in the diagnosis, monitoring, and treatment of this complex ocular disease.

This Special Issue seeks to foster collaboration among researchers, clinicians, and industry professionals, facilitating the dissemination of knowledge and the exchange of ideas in the field of glaucoma. We invite original research articles, comprehensive reviews, and perspectives that cover a broad range of topics, including, but not limited to, the following:

  • Novel diagnostic techniques: articles elucidating the development and clinical application of innovative imaging modalities, genetic testing, and biomarkers for early detection and accurate diagnosis;
  • Advanced therapeutic interventions: pharmacological advancements and emerging therapies for glaucoma management, with an emphasis on their efficacy, safety, and long-term outcomes;
  • Artificial intelligence and digital health: research exploring the integration of artificial intelligence, machine learning, and digital health technologies in glaucoma screening, monitoring, and personalized treatment approaches.

Dr. Da-Wen Lu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Biomedicines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (7 papers)

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Research

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12 pages, 1987 KiB  
Article
Possible Causal Association between Type 2 Diabetes and Glycaemic Traits in Primary Open-Angle Glaucoma: A Two-Sample Mendelian Randomisation Study
by Je Hyun Seo and Young Lee
Biomedicines 2024, 12(4), 866; https://0-doi-org.brum.beds.ac.uk/10.3390/biomedicines12040866 - 15 Apr 2024
Viewed by 468
Abstract
Existing literature suggests a controversial relationship between type 2 diabetes mellitus (T2D) and glaucoma. This study aimed to examine the potential causal connection between T2D and glycaemic traits (fasting glucose [FG] and glycated haemoglobin [HbA1c] levels) as exposures to primary open-angle glaucoma (POAG) [...] Read more.
Existing literature suggests a controversial relationship between type 2 diabetes mellitus (T2D) and glaucoma. This study aimed to examine the potential causal connection between T2D and glycaemic traits (fasting glucose [FG] and glycated haemoglobin [HbA1c] levels) as exposures to primary open-angle glaucoma (POAG) in multi-ethnic populations. Single-nucleotide polymorphisms associated with exposure to T2D, FG, and HbA1c were selected as instrumental variables with significance (p < 5.0 × 10−8) from the genome-wide association study (GWAS)-based meta-analysis data available from the BioBank Japan and the UK Biobank (UKB). The GWAS for POAG was obtained from the meta-analyses of Genetic Epidemiology Research in Adult Health and Aging and the UKB. A two-sample Mendelian randomisation (MR) study was performed to assess the causal estimates using the inverse-variance weighted (IVW) method, and MR-Pleiotropy Residual Sum and Outlier test (MR–PRESSO). Significant causal associations of T2D (odds ratio [OR] = 1.05, 95% confidence interval [CI] = [1.00–1.10], p = 0.031 in IVW; OR = 1.06, 95% CI = [1.01–1.11], p = 0.017 in MR–PRESSO) and FG levels (OR = 1.19, 95% CI = [1.02–1.38], p = 0.026 in IVW; OR = 1.17, 95% CI = [1.01–1.35], p = 0.041 in MR–PRESSO) with POAG were observed, but not in HbA1c (all p > 0.05). The potential causal relationship between T2D or FG and POAG highlights its role in the prevention of POAG. Further investigation is necessary to authenticate these findings. Full article
(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches)
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11 pages, 1641 KiB  
Article
Diagnosis of Glaucoma Based on Few-Shot Learning with Wide-Field Optical Coherence Tomography Angiography
by Kyoung Ok Yang, Jung Min Lee, Younji Shin, In Young Yoon, Jun Won Choi and Won June Lee
Biomedicines 2024, 12(4), 741; https://0-doi-org.brum.beds.ac.uk/10.3390/biomedicines12040741 - 27 Mar 2024
Viewed by 583
Abstract
This study evaluated the utility of incorporating deep learning into the relatively novel imaging technique of wide-field optical coherence tomography angiography (WF-OCTA) for glaucoma diagnosis. To overcome the challenge of limited data associated with this emerging imaging, the application of few-shot learning (FSL) [...] Read more.
This study evaluated the utility of incorporating deep learning into the relatively novel imaging technique of wide-field optical coherence tomography angiography (WF-OCTA) for glaucoma diagnosis. To overcome the challenge of limited data associated with this emerging imaging, the application of few-shot learning (FSL) was explored, and the advantages observed during its implementation were examined. A total of 195 eyes, comprising 82 normal controls and 113 patients with glaucoma, were examined in this study. The system was trained using FSL instead of traditional supervised learning. Model training can be presented in two distinct ways. Glaucoma feature detection was performed using ResNet18 as a feature extractor. To implement FSL, the ProtoNet algorithm was utilized to perform task-independent classification. Using this trained model, the performance of WF-OCTA through the FSL technique was evaluated. We trained the WF-OCTA validation method with 10 normal and 10 glaucoma images and subsequently examined the glaucoma detection effectiveness. FSL using the WF-OCTA image achieved an area under the receiver operating characteristic curve (AUC) of 0.93 (95% confidence interval (CI): 0.912–0.954) and an accuracy of 81%. In contrast, supervised learning using WF-OCTA images produced worse results than FSL, with an AUC of 0.80 (95% CI: 0.778–0.823) and an accuracy of 50% (p-values < 0.05). Furthermore, the FSL method using WF-OCTA images demonstrated improvement over the conventional OCT parameter-based results (all p-values < 0.05). This study demonstrated the effectiveness of applying deep learning to WF-OCTA for glaucoma diagnosis, highlighting the potential of WF-OCTA images in glaucoma diagnostics. Additionally, it showed that FSL could overcome the limitations associated with a small dataset and is expected to be applicable in various clinical settings. Full article
(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches)
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20 pages, 11365 KiB  
Article
Immune Analysis Using Vitreous Optical Coherence Tomography Imaging in Rats with Steroid-Induced Glaucoma
by Maria J. Rodrigo, Manuel Subías, Alberto Montolío, Teresa Martínez-Rincón, Alba Aragón-Navas, Irene Bravo-Osuna, Luis E. Pablo, Jose Cegoñino, Rocío Herrero-Vanrell, Elena Garcia-Martin and Amaya Pérez del Palomar
Biomedicines 2024, 12(3), 633; https://0-doi-org.brum.beds.ac.uk/10.3390/biomedicines12030633 - 13 Mar 2024
Viewed by 760
Abstract
Glaucoma is a multifactorial pathology involving the immune system. The subclinical immune response plays a homeostatic role in healthy situations, but in pathological situations, it produces imbalances. Optical coherence tomography detects immune cells in the vitreous as hyperreflective opacities and these are subsequently [...] Read more.
Glaucoma is a multifactorial pathology involving the immune system. The subclinical immune response plays a homeostatic role in healthy situations, but in pathological situations, it produces imbalances. Optical coherence tomography detects immune cells in the vitreous as hyperreflective opacities and these are subsequently characterised by computational analysis. This study monitors the changes in immunity in the vitreous in two steroid-induced glaucoma (SIG) animal models created with drug delivery systems (microspheres loaded with dexamethasone and dexamethasone/fibronectin), comparing both sexes and healthy controls over six months. SIG eyes tended to present greater intensity and a higher number of vitreous opacities (p < 0.05), with dynamic fluctuations in the percentage of isolated cells (10 µm2), non-activated cells (10–50 µm2), activated cells (50–250 µm2) and cell complexes (>250 µm2). Both SIG models presented an anti-inflammatory profile, with non-activated cells being the largest population in this study. However, smaller opacities (isolated cells) seemed to be the first responder to noxa since they were the most rounded (recruitment), coinciding with peak intraocular pressure increase, and showed the highest mean Intensity (intracellular machinery), even in the contralateral eye, and a major change in orientation (motility). Studying the features of hyperreflective opacities in the vitreous using OCT could be a useful biomarker of glaucoma. Full article
(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches)
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13 pages, 1704 KiB  
Article
Endocyclophotocoagulation Combined with Phacoemulsification in Glaucoma Treatment: Five-Year Results
by Bartłomiej Bolek, Adam Wylęgała, Małgorzata Rebkowska-Juraszek and Edward Wylęgała
Biomedicines 2024, 12(1), 186; https://0-doi-org.brum.beds.ac.uk/10.3390/biomedicines12010186 - 15 Jan 2024
Viewed by 711
Abstract
Background: this study aimed to assess the effectiveness and safety of phaco-endocyclophotocoagulation (phaco-ECP) in patients with glaucoma over five consecutive years. Methods: Thirty-eight patients (38 eyes) with primary and secondary glaucoma were enrolled to undergo phaco-ECP (Endo Optiks URAM E2, Beaver-Visitec International, Waltham, [...] Read more.
Background: this study aimed to assess the effectiveness and safety of phaco-endocyclophotocoagulation (phaco-ECP) in patients with glaucoma over five consecutive years. Methods: Thirty-eight patients (38 eyes) with primary and secondary glaucoma were enrolled to undergo phaco-ECP (Endo Optiks URAM E2, Beaver-Visitec International, Waltham, MA, USA). The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, and visual acuity after phaco-ECP. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as a cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and in the first week and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively. Results: The mean ± SD values of IOP preoperatively, at 12, 24, 36, 48, and 60 months postoperatively were 22.6 ± 6.7 mmHg, 15.9 ± 3.9 mmHg (p < 0.001), 15.9 ± 2.9 mmHg (p < 0.001), 15.6 ± 2.7 mmHg (p < 0.001), 15.5 ± 3.8 mmHg (p < 0.001), and 15.2 ± 2.6 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 32.7%. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. The qualified success rate was 40.6%. All patients at the 60-month follow-up visit required the use of antiglaucoma medications—none of the patients achieved complete success. During the follow-up period, nine patients (28.3%) that required retreatment due to nonachievement of the target IOP were considered failures. Six patients (15.8%) were lost from the follow-up. A total of 23 patients were evaluated 60 months after their phaco-ECP. Complications directly associated with the procedure, such as corneal edema (25.6%), IOP spikes (20.5%), IOL dislocation (2.6%), and uveitis (12.8%), were observed in our patients. Hypotony was not observed in any of our patients. Conclusions: The phaco-ECP procedure was effective, well-tolerated, and safe for reducing IOP in glaucoma patients with cataracts over a long-term follow-up. Randomized, larger-scale studies are required to validate the results obtained. Full article
(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches)
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12 pages, 2119 KiB  
Article
The Preserflo MicroShunt Affects Microvascular Flow Density in Optical Coherence Tomography Angiography
by Jens Julian Storp, Hannah Schatten, Friederike Elisabeth Vietmeier, Ralph-Laurent Merté, Larissa Lahme, Julian Alexander Zimmermann, Verena Anna Englmaier, Nicole Eter and Viktoria Constanze Brücher
Biomedicines 2023, 11(12), 3254; https://0-doi-org.brum.beds.ac.uk/10.3390/biomedicines11123254 - 08 Dec 2023
Viewed by 690
Abstract
Intraocular pressure (IOP) lowering surgery has been shown to alter microvascular density in glaucoma patients. The aim of this study is to report changes in retinal flow density (FD) over the course of treatment with the Preserflo MicroShunt, using optical coherence tomography angiography [...] Read more.
Intraocular pressure (IOP) lowering surgery has been shown to alter microvascular density in glaucoma patients. The aim of this study is to report changes in retinal flow density (FD) over the course of treatment with the Preserflo MicroShunt, using optical coherence tomography angiography (OCTA). 34 eyes from 34 patients who underwent Preserflo MicroShunt implantation were prospectively enrolled in this study. OCTA imaging was conducted at the superficial (SCP), deep (DCP) and radial peripapillary plexus (RPC) levels. The progression of FD and IOP was assessed at different time points from baseline to six months postoperatively for the entire patient population, as well as disease severity subgroups. The Preserflo MicroShunt achieved a significant reduction in IOP over the course of six months (median: 8 mmHg; p < 0.01). FD values of the SCP and DCP did not show significant fluctuations, even after adjusting for disease severity. FD of the RPC decreased significantly over the course of six months postoperatively from 42.31 at baseline to 39.59 at six months postoperatively (p < 0.01). The decrease in peripapillary FD was strongest in patients with advanced glaucoma (median: −3.58). These observations hint towards dysfunctional autoregulatory mechanisms in capillaries surrounding the optic nerve head in advanced glaucoma. In comparison, the microvascular structure of the macula appeared more resilient to changes in IOP. Full article
(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches)
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11 pages, 2458 KiB  
Article
Long-Term Clinical Outcomes of Ahmed Valve Implantation in Aniridic Glaucoma
by Bartłomiej Bolek, Edward Wylęgała and Dorota Tarnawska
Biomedicines 2023, 11(11), 2996; https://0-doi-org.brum.beds.ac.uk/10.3390/biomedicines11112996 - 08 Nov 2023
Viewed by 542
Abstract
Background: This study assessed the efficacy and safety of Ahmed valve implantation in patients with aniridic glaucoma for three consecutive years. Methods: Six adult patients (seven eyes) with Ahmed valve (AV) implants for aniridic glaucoma were enrolled in the study. The primary outcome [...] Read more.
Background: This study assessed the efficacy and safety of Ahmed valve implantation in patients with aniridic glaucoma for three consecutive years. Methods: Six adult patients (seven eyes) with Ahmed valve (AV) implants for aniridic glaucoma were enrolled in the study. The primary outcome measures were intraocular pressure reduction, glaucoma medication use, success rates, and visual acuity after AV implantation. A 30% reduction in IOP from baseline without the need for re-intervention was considered an effective treatment. The cessation of antiglaucoma medications was defined as complete success. Intraoperative and postoperative complications were included as secondary outcome measures. Measurements were performed preoperatively, at the first week, and 1, 3, 6, 12, 18, 24, 30, and 36 months postoperatively. Results: A total of seven eyes (6 patients) were evaluated 36 months after AV implantation. The mean ± SD values of IOP preoperatively at 1 day, 1 week, and 1, 3, 6, 12, 18, 24, 30, and 36 months postoperatively were 30.4 ± 4.0 mmHg, 14.6 ± 4.6 mmHg, 16.1 ± 4.6 mmHg, 20.7 ± 7.0 mmHg, 14.5 ± 2.7 mmHg, 16.5 ± 5.9 mmHg, 16.2 ± 4.0 mmHg, 16.3 ± 4.3 mmHg, 17.2 ± 10.1 mmHg, 17.6 ± 6.9 mmHg, and 18.2 ± 5.5 mmHg, respectively. At the last follow up, the mean IOP was reduced by 40.2%. The qualified success rate was 85.7%. One patient (one eye) at the last follow-up visit did not require antiglaucoma medications, resulting in a complete success rate of 14.3%. Intra- and postoperative mild or moderate subconjunctival bleeding was observed in all the patients. No other major/minor intraoperative or postoperative complications were noted. Conclusions: In long-term follow up, the AV implantation procedure is well-tolerated and relatively safe for reducing IOP in adult aniridia patients with glaucoma. These results should be validated through studies involving a larger patient cohort. Full article
(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches)
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Review

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12 pages, 279 KiB  
Review
Olfactory Dysfunction and Glaucoma
by Valeria Iannucci, Alice Bruscolini, Giannicola Iannella, Giacomo Visioli, Ludovico Alisi, Mauro Salducci, Antonio Greco and Alessandro Lambiase
Biomedicines 2024, 12(5), 1002; https://0-doi-org.brum.beds.ac.uk/10.3390/biomedicines12051002 - 02 May 2024
Viewed by 102
Abstract
Background: Olfactory dysfunction is a well-known phenomenon in neurological diseases with anosmia and hyposmia serving as clinical or preclinical indicators of Alzheimer’s disease, Parkinson’s disease, and other neurodegenerative disorders. Since glaucoma is a neurodegenerative disease of the visual system, it may also entail [...] Read more.
Background: Olfactory dysfunction is a well-known phenomenon in neurological diseases with anosmia and hyposmia serving as clinical or preclinical indicators of Alzheimer’s disease, Parkinson’s disease, and other neurodegenerative disorders. Since glaucoma is a neurodegenerative disease of the visual system, it may also entail alterations in olfactory function, warranting investigation into potential sensory interconnections. Methods: A review of the current literature of the last 15 years (from 1 April 2008 to 1 April 2023) was conducted by two different authors searching for topics related to olfaction and glaucoma. Results: three papers met the selection criteria. According to these findings, patients with POAG appear to have worse olfaction than healthy subjects. Furthermore, certain predisposing conditions to glaucoma, such as pseudoexfoliation syndrome and primary vascular dysregulation, could possibly induce olfactory changes that can be measured with the Sniffin Stick test. Conclusions: the scientific literature on this topic is very limited, and the pathogenesis of olfactory changes in glaucoma is not clear. However, if the results of these studies are confirmed by further research, olfactory testing may be a non-invasive tool to assist clinicians in the early diagnosis of glaucoma. Full article
(This article belongs to the Special Issue Glaucoma: New Diagnostic and Therapeutic Approaches)
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